Claims SME

Claims SME – Property & Casualty (P&C) Insurance

Experience Required

• 5 to 8 years of end -to -end Property & Casualty (P&C) claims handling experience.
  
• Strong expertise in claims adjudication, coverage analysis, liability determination, and claims lifecycle management.
  
• Experience supporting process transitions, quality initiatives, and operational excellence programs.
  

Key Responsibilities

• Act as the Subject Matter Expert (SME) for P&C claims processes, policy coverage, and claims adjudication.
  
• Provide guidance and support to claims teams on complex claims, coverage interpretation, and liability assessments.
  
• Review high -value or complex claims to ensure accurate and compliant claim decisions.
  
• Support quality assurance activities through claim file reviews, audits, and feedback sessions.
  
• Assist in developing and maintaining Standard Operating Procedures (SOPs), process documentation, and training materials.
  
• Conduct knowledge -sharing sessions and mentor team members on claims best practices and industry standards.
  
• Identify process improvement opportunities and support implementation of operational efficiencies.
  
• Assist with new client transitions, workflow stabilization, and knowledge transfer activities.
  
• Collaborate with stakeholders to resolve escalations and ensure timely claim resolution.
  
• Monitor claims trends, identify risks, and recommend corrective actions to improve claim outcomes.
  
• Support reporting requirements, root cause analysis, and continuous improvement initiatives.
  

Skills Required

• Deep understanding of Property & Casualty (P&C) insurance claims, policy coverage, and claims handling practices.
  
• Strong analytical and problem -solving skills with the ability to evaluate complex claim scenarios.
  
• Excellent communication and stakeholder management abilities.
  
• Strong knowledge of claims quality standards, compliance requirements, and operational best practices.
  
• Experience conducting audits, quality reviews, and process assessments.
  
• Ability to support training, coaching, and knowledge management initiatives.
  
• Strong decision -making and escalation management skills.
  
• Proficiency in Microsoft Excel, PowerPoint, and operational reporting tools.
  
• Ability to manage multiple priorities in a fast -paced environment.